RESUMEN
BACKGROUND AND OBJECTIVE: Tendon segmentation is crucial for studying tendon-related pathologies like tendinopathy, tendinosis, etc. This step further enables detailed analysis of specific tendon regions using automated or semi-automated methods. This study specifically aims at the segmentation of Achilles tendon, the largest tendon in the human body. METHODS: This study proposes a comprehensive end-to-end tendon segmentation module composed of a preliminary superpixel-based coarse segmentation preceding the final segmentation task. The final segmentation results are obtained through two distinct approaches. In the first approach, the coarsely generated superpixels are subjected to classification using Random Forest (RF) and Support Vector Machine (SVM) classifiers to classify whether each superpixel belongs to a tendon class or not (resulting in tendon segmentation). In the second approach, the arrangements of superpixels are converted to graphs instead of being treated as conventional image grids. This classification process uses a graph-based convolutional network (GCN) to determine whether each superpixel corresponds to a tendon class or not. RESULTS: All experiments are conducted on a custom-made ankle MRI dataset. The dataset comprises 76 subjects and is divided into two sets: one for training (Dataset 1, trained and evaluated using leave-one-group-out cross-validation) and the other as unseen test data (Dataset 2). Using our first approach, the final test AUC (Area Under the ROC Curve) scores using RF and SVM classifiers on the test data (Dataset 2) are 0.992 and 0.987, respectively, with sensitivities of 0.904 and 0.966. On the other hand, using our second approach (GCN-based node classification), the AUC score for the test set is 0.933 with a sensitivity of 0.899. CONCLUSIONS: Our proposed pipeline demonstrates the efficacy of employing superpixel generation as a coarse segmentation technique for the final tendon segmentation. Whether utilizing RF, SVM-based superpixel classification, or GCN-based classification for tendon segmentation, our system consistently achieves commendable AUC scores, especially the non-graph-based approach. Given the limited dataset, our graph-based method did not perform as well as non-graph-based superpixel classifications; however, the results obtained provide valuable insights into how well the models can distinguish between tendons and non-tendons. This opens up opportunities for further exploration and improvement.
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Tendón Calcáneo , Aprendizaje Automático , Imagen por Resonancia Magnética , Redes Neurales de la Computación , Máquina de Vectores de Soporte , Humanos , Imagen por Resonancia Magnética/métodos , Tendón Calcáneo/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Algoritmos , Tendinopatía/diagnóstico por imagen , Tendinopatía/clasificación , Tendones/diagnóstico por imagenRESUMEN
BACKGROUND: The Achilles tendon is one of the thickest, largest, and strongest tendons in the human body. Biomechanically, the AT represents the conjoint tendon of the triceps surae muscle, placed in series with the plantar fascia (PF) to ensure force transmission from the triceps surae toward the toes during walking, running, and jumping. Commonly encountered in the diagnostic evaluation of heel pain, Achilles tendinopathy (AT) refers to a combination of pathological changes affecting the tendon itself often resulting from excessive repetitive stress and overuse. Nevertheless, increasing evidence demonstrates that structural alterations due to overuse or abnormal patterns of skeletal muscle activity are not necessarily restricted to the muscles or tendons but can also affect the fascial tissue. At the same time, there has been recent discussion regarding the role of the fascial tissue as a potential contributor to the pathophysiological mechanisms of the development of several musculoskeletal disorders including tendinopathies. To the best of our knowledge, ultrasound (US) imaging studies on the fascial structures related to the triceps surae complex, as well as their possible correlation with Achillodynia have never been presented in the current literature. METHODS: In the present study, a comparative US imaging evaluation of textural features of the suro-Achilleo-plantar complex was performed in 14 healthy controls and 14 symptomatic subjects complaining of midportion AT. The thickness of the Achilles tendon, paratenon, intermuscular fascia, and PF has been assessed with US. In addition, both groups underwent the Victorian Institute of Sport Assessment-Achilles (VISA-A), a disease-specific questionnaire that measures the severity of symptoms of AT. Correlations between quantitative ultrasound measures and VISA-A scores were determined through Pearson or Spearman's rho correlations. RESULTS: Our ultrasonographic findings revealed statistically significant differences (p<0.05) in Achilles tendon and paratenon thicknesses between AT patients and controls. No significant differences were observed between groups in PF at the calcaneal insertion as all mean measures were within the expected range of a normal PF on US imaging. In contrast, in tendinopathic subjects, the deep intermuscular fascia between medial gastrocnemius (MG) and soleus (SOL) muscles is significantly (p<0.01) and considerably thickened compared to those of healthy subjects. Moderate correlations exist between tendon and paratenon thicknesses (r= 0.54, p= 0.04) and between MG-SOL fascia and tendon thicknesses (r= 0.58, p= 0.03). Regarding symptom severity and US morphological findings, the Spearman ρ test showed no correlation. CONCLUSIONS: Our data demonstrate that, in symptomatic subjects, US alterations are not restricted to paratenon and intratendinous areas, but also affect upstream structures along the myofascial chain, resulting in thickening of the fascia interposed between MG and SOL muscles. Moreover, positive correlations were found between MG-SOL fascia thickening and abnormalities in AT, paratenon, and symptom severity. Thus, US alterations in the fascial system should be interpreted within the clinical context of patients with AT as they may in turn represent important predictors of subsequent clinical outcomes and could help healthcare professionals and clinicians to refine non-operative treatment strategies and rehabilitation protocols for this disease.
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Tendón Calcáneo , Fascia , Músculo Esquelético , Tendinopatía , Ultrasonografía , Humanos , Tendón Calcáneo/diagnóstico por imagen , Tendón Calcáneo/patología , Tendinopatía/diagnóstico por imagen , Tendinopatía/patología , Femenino , Estudios de Casos y Controles , Adulto , Fascia/diagnóstico por imagen , Fascia/patología , Fascia/anatomía & histología , Masculino , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Músculo Esquelético/anatomía & histología , Persona de Mediana EdadRESUMEN
Patellar tendinopathy is more prevalent in males versus female athletes and commonly presents in the medial region of the tendon. Separate measures of patellar tendon strain in the medial, central, and lateral regions of the tendon, however, have not been quantified. The purpose was to investigate the differences in tendon strain between the medial, lateral, and central regions of the patellar tendon in healthy men and women. Strain in the medial and lateral regions of the patellar tendon in healthy participants (10 males, 10 females) was evaluated using ultrasound during isometric quadriceps contractions at 20%, 40%, 60%, 80%, and 100% of maximum voluntary contraction (MVIC) in 60° and 90° of knee flexion. Central strain was also measured at 60% MVIC in 90° of knee flexion. Mixed models were used to determine strain between tendon regions and sex at 60% MVIC in 90° of knee flexion. Sequential modeling was used to fit region, sex, %MVIC, and angle to predict strain. The central region had less strain compared with both medial and lateral regions. The lateral region had higher strain compared with the medial region regardless of sex. Females had higher strain compared with males, regardless of region. Knee position did not influence tendon strain. Patellar tendon strain differs by region and sex. The varying prevalence between sex and in location of patellar tendinopathy may in part be explained by the unbalanced strains. Differential assessment of regional patellar tendon strain may be of importance for understanding injury risk and recovery with exercise.
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Ligamento Rotuliano , Tendinopatía , Ultrasonografía , Humanos , Ligamento Rotuliano/fisiología , Ligamento Rotuliano/diagnóstico por imagen , Masculino , Femenino , Adulto , Adulto Joven , Factores Sexuales , Tendinopatía/diagnóstico por imagen , Tendinopatía/fisiopatología , Músculo Cuádriceps/fisiología , Músculo Cuádriceps/diagnóstico por imagen , Contracción Isométrica/fisiología , Fenómenos BiomecánicosRESUMEN
We investigated oxidative status in patients with rotator cuff tendinopathy (RCT) and evaluated their relationship with radiological and clinical parameters. In this cross-section study, 88 patients with RCT (59 males and 29 females) and 86 healthy controls (66 males, 20 females) were enrolled. The sample consisted of nontraumatic patients who are suffering from shoulder pain because of rotator cuff disease, which was established by clinical tests and MRI scanning. Oxidative stress in patients with RCT was analyzed via the dynamic thiol/disulfide homeostasis (TDH). Thiol/disulfide homeostasis was measured by a new colorimetric method. Furthermore, oxidative stress was indirectly measured by serum total oxidant status (TOS), oxidative stress index (OSI), and total antioxidant capacity (TAC). Serum disulfide levels and the other oxidative stress parameters of the RCT group were significantly greater than those of the control group (P < .001 for all), whereas the anti-oxidative stress parameters remained unchanged (P > .05 for all). The lowest and highest serum disulfide levels were detected in patients with grades 1 and 3, respectively (P < .001). Furthermore, in a multiple regression analysis, the disulfide/natural thiol ratio (ß=-4.886, P = .004) and the MRI grading (ß=0.314, P=.001) were independently associated with the Western Ontario Rotator Cuff Index WORC score. We found an association between the levels of various serum markers of oxidative injury, especially serum disulfide levels, and the increasing severity of RCT. Thiol/disulfide homeostasis seems to play a critical role in RCT, both in the beginning and during the progression of disease.
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Imagen por Resonancia Magnética , Estrés Oxidativo , Manguito de los Rotadores , Tendinopatía , Humanos , Masculino , Femenino , Persona de Mediana Edad , Tendinopatía/diagnóstico por imagen , Tendinopatía/sangre , Imagen por Resonancia Magnética/métodos , Manguito de los Rotadores/diagnóstico por imagen , Estudios Transversales , Adulto , Compuestos de Sulfhidrilo/sangre , Disulfuros/sangre , Antioxidantes/metabolismo , Estudios de Casos y Controles , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/sangre , Dolor de Hombro/sangre , Anciano , Biomarcadores/sangreAsunto(s)
Calcinosis , Músculos del Cuello , Tendinopatía , Humanos , Tendinopatía/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Calcinosis/diagnóstico , Músculos del Cuello/diagnóstico por imagen , Músculos del Cuello/patología , Enfermedad Aguda , Resultado del Tratamiento , Imagen por Resonancia Magnética , Femenino , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE OF THE STUDY: In this study, we aimed to evaluate acromiohumeral distance (AHD) and supraspinatus tendon (ST) thickness measurements and their relationship with pain and function in ST pathologies. MATERIAL AND METHODS: The study included 111 patients and 25 healthy controls (HC). Patients were divided into 3 groups according to their diagnosis: non-tear tendinopathy (NTT), partial thickness tear (PTT), and full thickness tear (FTT). The AHD and ST thickness of the participants were measured with ultrasound. The pain and functional status of the patients were evaluated with the Numeric Rating Scale (NRS), The QuickDASH shortened version of the DASH Outcome Measure - Disabilities of the Arm Shoulder and Hand (QDASH), and Simple Shoulder Test (SST). RESULTS: The AHD value was significantly higher in the NTT group (p=0.000). The AHD value was significantly lower in the FTT group (p=0.000). ST thickness value was significantly lower in the PTT group compared to the NTT group (p=0.000). There was a positive correlation between ST thickness and BMI (r=0.553,p<0.01). There was a negative correlation between ST thickness and SST and a positive correlation between ST thickness (r=-0.223,p<0.05) and QDASH (r=0.276,p<0.05). CONCLUSIONS: We found that AHD and SST thicknesses significantly differed in the NTT, PTT, FTT, and HC groups. This difference may be important for diagnosis. In addition, the effect of obesity on ST thickness and the relationship between ST thickness and functional scores may be considered. Weight control may be effective at this point. KEY WORDS: acromiohumeral distance, supraspinatus tendon thickness, ultrasound.
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Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Ultrasonografía , Humanos , Ultrasonografía/métodos , Masculino , Femenino , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/fisiopatología , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Lesiones del Manguito de los Rotadores/fisiopatología , Persona de Mediana Edad , Adulto , Acromion/diagnóstico por imagen , Estudios de Casos y Controles , Dolor de Hombro/etiología , Dolor de Hombro/diagnóstico por imagen , Dolor de Hombro/fisiopatología , Tendinopatía/diagnóstico por imagen , Tendinopatía/fisiopatología , Dimensión del Dolor/métodosRESUMEN
PURPOSE: In correlation with magnetic resonance imaging (MRI), this study attempts to assess the effectiveness of the diagnostic of ultrasonography (US) features and shear wave elastography (SWE) in determining the different causes of heel pain. MATERIALS AND METHODS: 55 heels with a mean age of 38.33 ± 10.8 were included in the study (10 control cases and 41 cases, 4 of which had bilateral heel pain). There were 23 female cases (56.1%) and 18 male cases (43.95%). Examinations using shear wave elastography (SWE) and ultrasound (US) were done in different positions. MRI and the obtained data were correlated. RESULTS: When used to diagnose different heel pain causes, ultrasound demonstrated great sensitivity and specificity. SWE demonstrated a good correlation with MRI findings and enhanced the ultrasound's diagnostic precision in identifying plantar fasciitis early on (increased accuracy from 88.9 to 93.33% with 100% sensitivity and 83.3% specificity) and Achilles tendinopathy (increased accuracy from 88.9 to 97.8 with 94.7% sensitivity and 100% specificity). CONCLUSION: In summary, we concluded that heel pain can be efficiently examined by both ultrasound (US) and shear wave elastography (SWE) with the former being used as the primary effective tool and the latter being done to increase diagnostic accuracy. We also concluded that SWE improved the ultrasound's diagnostic precision in identifying patients with early plantar fasciitis and Achilles tendinopathy and showed a robust relationship with clinical outcomes, enhancing patient evaluation and follow-up.
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Diagnóstico por Imagen de Elasticidad , Talón , Sensibilidad y Especificidad , Ultrasonografía , Humanos , Diagnóstico por Imagen de Elasticidad/métodos , Masculino , Femenino , Talón/diagnóstico por imagen , Adulto , Estudios Transversales , Diagnóstico Diferencial , Persona de Mediana Edad , Ultrasonografía/métodos , Fascitis Plantar/diagnóstico por imagen , Dolor/diagnóstico por imagen , Dolor/etiología , Imagen por Resonancia Magnética , Tendinopatía/diagnóstico por imagen , Tendón Calcáneo/diagnóstico por imagenRESUMEN
This study aimed to examine the association between calcific rotator cuff tendinopathy (RCT) and nephrolithiasis and/or cholelithiasis. A case-control study was conducted on patients diagnosed with RCT between June 2016 and June 2022. RCT was confirmed by ultrasound, and patients were divided into 2 groups: calcific RCT (case) and non-calcific RCT (control). Data were collected retrospectively from electronic medical records and completed by phone calls, looking for a history of nephrolithiasis and/or cholelithiasis; based on clinical features or incidental findings on abdominal and pelvic imaging. A total of 210 patients with RCT were included. Among the 95 cases of calcific RCT, 43 had a history of lithiasis (45.3%) against 23 (20%) from the non-calcific RCT group (Pâ <â .001); 21 patients suffered from nephrolithiasis (22.1%) and 26 had cholelithiasis (27.4%) versus 10 (8.7%) (Pâ =â .006) and 16 (13.9%) (Pâ =â .015) in the non-calcific RCT group, respectively. Logistic regression showed that the independent predictors of calcific RCT included a history of nephrolithiasis (OR, 4.38; 95% CI: 1.61-11.92, Pâ =â .004) and a history of cholelithiasis (OR, 3.83; 95% CI: 1.64-8.94, Pâ =â .002). In patients with calcific RCT, the occurrence of lithiasis was significantly associated in the bivariate analysis with higher age, body mass index, fasting blood sugar, and HbA1c (all with Pâ <â .05), but only with the presence of another site of calcific tendinopathy than the shoulder (OR, 3.11; 95% CI: 1.12-8.65, Pâ =â .03) in the multivariate analysis. Nephrolithiasis and/or cholelithiasis are associated with calcific RCT, and their presence predicts calcific RCT at least 3 times. Further research is required to determine the common risk factors and preventive measures against lithogenesis in patients with calcific RCT, nephrolithiasis, and cholelithiasis.
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Calcinosis , Colelitiasis , Nefrolitiasis , Tendinopatía , Humanos , Femenino , Masculino , Persona de Mediana Edad , Colelitiasis/complicaciones , Colelitiasis/epidemiología , Tendinopatía/epidemiología , Tendinopatía/diagnóstico por imagen , Tendinopatía/etiología , Tendinopatía/complicaciones , Estudios de Casos y Controles , Nefrolitiasis/epidemiología , Nefrolitiasis/etiología , Nefrolitiasis/complicaciones , Estudios Retrospectivos , Calcinosis/diagnóstico por imagen , Calcinosis/complicaciones , Calcinosis/epidemiología , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/patología , Adulto , Anciano , Factores de Riesgo , UltrasonografíaRESUMEN
PURPOSE: This study aims to assess ultrashort-TE magnetization transfer (UTE-MT) imaging of collagen degradation using an in vitro model of rotator cuff tendinopathy. METHODS: Thirty-six supraspinatus tendon specimens were divided into three groups and treated with 600 U collagenase (Group 1), 150 U collagenase (Group 2), and phosphate buffer saline (Group 3). UTE-MT imaging was performed to assess changes in macromolecular fraction (MMF), macromolecule transverse relaxation time (T2m), water longitudinal relaxation rate constant (R1m), the magnetization exchange rate from the macromolecular to water pool (Rm0 w) and from water to the macromolecular pool (Rm0 m), and magnetization transfer ratio (MTR) at baseline and following digestion and their differences between groups. Biochemical and histological studies were conducted to determine the extent of collagen degradation. Correlation analyses were performed with MMF, T2m, R1m, Rm0 w, Rm0 m, and MTR, respectively. Univariate and multivariate linear regression analyses were performed to evaluate combinations of UTE-MT parameters to predict collagen degradation. RESULTS: MMF, T2m, R1m, Rm0 m, and MTR decreased after digestion. MMF (r = -0.842, p < 0.001), MTR (r = -0.78, p < 0.001), and Rm0 m (r = -0.662, p < 0.001) were strongly negatively correlated with collagen degradation. The linear regression model of differences in MMF and Rm0 m before and after digestion explained 68.9% of collagen degradation variation in the tendon. The model of postdigestion in MMF and T2m and the model of MTR explained 54.2% and 52.3% of collagen degradation variation, respectively. CONCLUSION: This study highlighted the potential of UTE-MT parameters for evaluation of supraspinatus tendinopathy.
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Colágeno , Imagen por Resonancia Magnética , Manguito de los Rotadores , Tendinopatía , Tendinopatía/diagnóstico por imagen , Tendinopatía/metabolismo , Colágeno/metabolismo , Humanos , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/metabolismo , Imagen por Resonancia Magnética/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Colagenasas/metabolismo , Tendones/diagnóstico por imagen , Tendones/metabolismo , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
BACKGROUND: The mechanistic response of rotator cuff tendons to exercises within the context of rotator cuff-related shoulder pain (RCRSP) remains a significant gap in current research. A greater understanding of this response can shed light on why individuals exhibit varying responses to exercise interventions. It can also provide information on the influence of certain types of exercise on tendons. The primary aim of this article is to explore if changes in supraspinatus tendon thickness (SSTT) ratio differ between exercise interventions (high load vs. low load). The secondary aims are to explore if changes in SSTT ratio differ between ultrasonographic tendinopathy subgroups (reactive vs. degenerative) and if there are associations between tendinopathy subgroups, changes in tendon thickness ratio, and clinical outcomes (disability). METHODS: This study comprises secondary analyses of the combined dataset from two randomized controlled trials that compared high and low-load exercises in patients with RCRSP. In those trials, different exercise interventions were compared: 1) progressive high-load strengthening exercises and 2) low-load strengthening with or without motor control exercises. In 1 trial, there was also a third group that was not allocated to exercises (education only). Ultrasound-assessed SSTT ratio, derived from comparing symptomatic and asymptomatic sides, served as the primary measure in categorizing participants into tendinopathy subgroups (reactive, normal and degenerative) at baseline. RESULTS: Data from 159 participants were analyzed. Two-way repeated measures ANOVAs revealed significant Group (P < .001) and Group × Time interaction (P < .001) effects for the SSTT ratio in different tendinopathy subgroups, but no Time effect (P = .63). Following the interventions, SSTT ratio increased in the "Degenerative" subgroup (0.14 [95% confidence interval {CI}: 0.09-0.19]), decreased in the "Reactive" subgroup (-0.11 [95% CI: -0.16 to -0.06]), and remained unchanged in the "Normal" subgroup (-0.01 [95% CI: -0.04 to 0.02]). There was no Time (P = .21), Group (P = .61), or Group × Time interaction (P = .66) effect for the SSTT ratio based on intervention allocation. Results of the linear regression did not highlight any significant association between the tendinopathy subgroup (P = .25) or change in SSTT ratio (P = .40) and change in disability score. CONCLUSION: Findings from this study suggest that, over time, SSTT in individuals with RCRSP tends to normalize, compared to the contralateral side, regardless of the exercise intervention. Different subgroups of symptomatic tendons behave differently, emphasizing the need to potentially consider tendinopathy subtypes in RCRSP research. Future adequately powered studies should investigate how those different tendinopathy subgroups may predict long-term clinical outcomes.
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Terapia por Ejercicio , Manguito de los Rotadores , Dolor de Hombro , Tendinopatía , Humanos , Terapia por Ejercicio/métodos , Femenino , Persona de Mediana Edad , Masculino , Manguito de los Rotadores/diagnóstico por imagen , Dolor de Hombro/terapia , Dolor de Hombro/etiología , Tendinopatía/terapia , Tendinopatía/diagnóstico por imagen , Ultrasonografía , Anciano , Ensayos Clínicos Controlados Aleatorios como Asunto , Lesiones del Manguito de los Rotadores/terapia , Lesiones del Manguito de los Rotadores/diagnóstico por imagen , Adulto , Resultado del TratamientoAsunto(s)
Calcinosis , Tendinopatía , Humanos , Tendinopatía/complicaciones , Tendinopatía/diagnóstico por imagen , Tendinopatía/diagnóstico , Calcinosis/diagnóstico por imagen , Calcinosis/diagnóstico , Calcinosis/complicaciones , Tendones/patología , Tendones/diagnóstico por imagen , Masculino , Femenino , Pie/patología , Persona de Mediana EdadRESUMEN
The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior-posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior-posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8-6.9) mm for the midportion region and 3.7 (2.8-4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation -2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was -0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × -0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3-3.2, p < 0.001) for the midportion and 1.4 mm (1.1-1.7, p < 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).
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Tendón Calcáneo , Tendinopatía , Ultrasonografía , Humanos , Tendón Calcáneo/diagnóstico por imagen , Tendón Calcáneo/anatomía & histología , Tendón Calcáneo/patología , Masculino , Femenino , Tendinopatía/diagnóstico por imagen , Tendinopatía/patología , Estudios Transversales , Adulto , Persona de Mediana Edad , Valores de Referencia , Anciano , Índice de Masa Corporal , Adulto Joven , Factores SexualesRESUMEN
Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.
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Tendón Calcáneo , Imagen por Resonancia Magnética , Tendinopatía , Humanos , Tendón Calcáneo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tendinopatía/diagnóstico por imagen , Masculino , Femenino , Adulto , Reproducibilidad de los Resultados , Adulto Joven , Persona de Mediana Edad , Articulación del Tobillo/diagnóstico por imagenRESUMEN
BACKGROUND: Insertional Achilles tendinopathy (IAT) is a common pathology with multiple surgical interventions available for treatment. The Zadek, dorsal closing wedge calcaneal osteotomy (ZO) has been demonstrated to be effective treatment of IAT. There have been various recommendations in the literature as to what measurement of wedge removal should be considered ideal to produce greatest postoperative range of motion (ROM), thus postoperative biomechanical potential. Accordingly, the purpose of this cadaveric study was to assess the range of motion achieved after various measurements of wedge removal by ZO. METHODS: The ZO was performed on six cadaveric specimens. A 7.5 mm and 15 mm wedge osteotomy was marked and sequentially completed on each specimen. Lateral fluoroscopic imaging was utilized to take preoperative and postoperative ROM measurements for each osteotomy. Dorsiflexion (DF) and plantarflexion (PF) ROM arcs were measured for each wedge size and compared by t-test. Effect sizes were calculated by Cohen's d analysis. RESULTS: Maximal DF was 110.87 ± 12.97 deg in the pre-osteotomy state. Removal of a 7.5 mm wedge improved DF by 8 deg to a mean 102.93 ± 13.81 deg (p = 0.08). Removal of a 15 mm wedge improved DF by 16 deg to a mean 95.96 ± 11.41 deg (p = 0.003). Cohen's d and effect size calculation demonstrated a 7.5 mm wedge to have a small effect on DF, while a 15 mm wedge had a medium effect (0.29, 0.52 respectively). Maximal PF did not change significantly amongst the pre-osteotomy, 7.5 mm wedge, or 15 mm wedge positions. ICC was 0.96. CONCLUSION: Based on the results presented in this study, removal of a 15 mm wedge with ZO yields significant and greater improvement in ROM than a 7.5 mm wedge. We hope the current study will better inform preoperative planning for ZO. STUDY TYPE: Prospective Cadaver Study. LEVEL OF EVIDENCE: V.
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Cadáver , Calcáneo , Osteotomía , Rango del Movimiento Articular , Humanos , Osteotomía/métodos , Calcáneo/cirugía , Calcáneo/diagnóstico por imagen , Tendón Calcáneo/cirugía , Tendinopatía/cirugía , Tendinopatía/diagnóstico por imagen , Masculino , Femenino , AncianoRESUMEN
PURPOSE: This study explores the use of ultrasound-guided Hyaluronic Acid (HA) injections for Insertional Achilles Tendinopathy (IAT). METHODS: A cohort of 15 ankles diagnosed with IAT received three weekly ultrasound-guided HA injections. The Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire scored the severity of symptoms and functional impairment before treatment, and at one and six months post-treatment. RESULTS: Significant improvement was observed in VISA-A scores post-treatment, rising from an average baseline of 34.8 ± 15.2 (11-63) to 53.6 ± 20.9 (15-77) after one month, and then to 50.7 ± 18.6 (20-75) after six months. No adverse reactions were noted, underscoring the safety of the intervention. CONCLUSION: The pilot study presents HA injections as a potentially effective treatment for IAT, while interpretation of these findings must take into account the variability in results, indicating a range of patient responses. It encourages further research to confirm these findings and to explore HA's full potential in managing IAT, despite the limitations of a small sample size and lack of control group.
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Tendón Calcáneo , Deportes , Tendinopatía , Humanos , Ácido Hialurónico/uso terapéutico , Proyectos Piloto , Tendinopatía/diagnóstico por imagen , Tendinopatía/tratamiento farmacológico , Resultado del TratamientoRESUMEN
In the online version of the article, a change was made in the author's affiliation section. The affiliation of Dr. Paolo Spinnato and Dr. Maria Pilar Aparisi Gomez in the online version of the article entitled "Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review" has been updated in "Current Medical Imaging", 2024; 20: e100423215585 [1]. The original article can be found online at: https://www. eurekaselect.com/article/130811 Original: Federica Delbello1, Paolo Spinnato2,* and Maria Pilar Aparisi Gomez3 1Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy 2Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand 3Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain Corrected: Federica Delbello1, Paolo Spinnato2,* and Maria Pilar Aparisi Gomez3,4 1Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy 2IRCCS Istituto Ortopedico Rizzoli, Bologna Italy 3Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain 4Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
Asunto(s)
Calcinosis , Manguito de los Rotadores , Tendinopatía , Humanos , Calcinosis/diagnóstico por imagen , Tendinopatía/diagnóstico por imagen , Manguito de los Rotadores/diagnóstico por imagenRESUMEN
This study aims to identify preoperative risk factors for iliopsoas tendonitis after total hip arthroplasty, a complication typically attributed to acetabular cup position and orientation, using a validated iliopsoas impingement detection simulation. Analyzing CT scans and X-rays of 448 patients using a validated preoperative planning protocol, patients were simulated for iliopsoas impingement and categorized into at-risk and not at-risk groups based on a prior validation study, with a 23% at-risk incidence. Implementing a propensity score matching algorithm to reduce covariate imbalance, we identified factors that may exacerbate risk of iliopsoas tendonitis. Parameters that were investigated included standing pelvic tilt, functional femoral rotation, and the difference between the planned acetabular cup diameter and native femoral head diameter (ΔC-NFH). Comparing pelvic tilt, we found a significant difference between the groups (at-risk: -6.0°, not at-risk: -0.7°; p << 0.01). A similar trend was noted for ΔC-NFH (at-risk: +5.7 mm, not at-risk: +5.1 mm; p = 0.01). Additional simulations of at-risk patients indicated increased anteversion of the acetabular cup reduces impingement risk more effectively than medialisation. These findings suggest that spinopelvic parameters may exacerbate iliopsoas irritation risk, underscoring their importance in preoperative planning and patient expectation management. Similar findings of a greater than 6 mm difference between cup size and native femoral head diameter being a significant risk for iliopsoas tendonitis have been observed before, underscoring its potential veracity. These results may provide surgeons with a simple threshold that can be used in determining a cup size to reduce the risk of iliopsoas tendonitis.
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Artroplastia de Reemplazo de Cadera , Tendinopatía , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Tendinopatía/etiología , Tendinopatía/diagnóstico por imagen , Factores de Riesgo , Masculino , Femenino , Persona de Mediana Edad , Anciano , Músculos Psoas/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
RATIONALE AND OBJECTIVES: To determine the diagnostic accuracy and reproducibility of conventional MR imaging (MRI) of the shoulder in evaluating biceps pulley lesions using arthroscopy as the standard of reference. METHODS: In a retrospective study, MR examinations of 68 patients with arthroscopically proven torn or intact biceps pulley were assessed for the presence of pulley lesions by three radiologists. The following criteria were evaluated: displacement of the long head of the biceps tendon (LHBT) relative to the subscapularis tendon (displacement sign), subluxation/dislocation of the LHBT, the integrity of the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL), lesions of the supraspinatus (SSP) and subscapularis (SSC) tendons adjacent to the rotator interval, presence of biceps tendinopathy and subacromial bursitis. RESULTS: There were 42 patients with pulley lesions in the study group. Conventional MR imaging showed an overall sensitivity of 95.2%, 88.1% and 92.9%, a specificity of 61.5%, 73.1%, and 80.8% and an accuracy of 82.4%, 82.4% and 88.2% in the diagnosis of pulley lesions. Interobserver agreement was substantial (multirater k = 0.75). Biceps tendinopathy (97.6%, 95.2%, 97.6%), defects of the SGHL (86.3%, 81.0%, 88.1%) and the displacement sign (88.1%, 81.0%, 85.7%) were the most sensitive diagnostic criteria. Subluxation/dislocation of the LHBT was insensitive (78.6%, 42.9%, 33.3%), but specific (69.2%, 100,0%, 96.2%). CONCLUSION: In the diagnosis of pulley lesions, conventional MR imaging is reproducible and shows high sensitivity and accuracy but moderate specificity.
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Imagen por Resonancia Magnética , Sensibilidad y Especificidad , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Reproducibilidad de los Resultados , Estudios Retrospectivos , Anciano , Artroscopía , Traumatismos de los Tendones/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Lesiones del Hombro/diagnóstico por imagen , Adolescente , Adulto Joven , Tendinopatía/diagnóstico por imagenRESUMEN
BACKGROUND: Ultrasound-guided galvanic electrolysis technique (USGET) is an innovative mini-invasive intervention with the potential to optimise outcomes in the treatment of Achille's tendinopathy (AT). OBJECTIVE: The aim of this pilot study is to evaluate the efficacy of adding USGET to conventional eccentric exercise treatment in patients with chronic AT. METHODS: Inclusion criteria were patients with unilateral non-insertional AT, pain lasting > 3 months, aged 25-60 years. Patients were randomised in two groups receiving the same physiotherapy treatment (2 sessions per week for 8 weeks). In addition, the experimental group received three USGET stimulations, one every 15 days. Outcome measures were assessment of Achilles tendinopathy severity using the Victorian Institute of Sport Assessment-Achilles (VISA-A) and pain intensity using the Visual Analogue Scale (VAS). Assessment points occurred at the onset of treatment (T0), its conclusion (T1), and subsequent follow-ups at one (T2) and two months (T3). RESULTS: Out of the 52 patients who met the study inclusion criteria, two participants withdrew from the study, resulting in a total of 50 subjects who completed the research. None of the parameters showed a different distribution at T1 (p> 0.337). At T2, there was a statistical difference in VISA-A (p= 0.010) and its subscales and VAS (p= 0.002) in the USGET group. At T3, both groups improved with a statistical difference observed in VISA-A (p< 0.001) and its subscales Pain (p= 0.004), Function (p= 0.003) and Sport (p= 0.002), but the EG patients showed a greater improvement. No adverse events were reported. CONCLUSION: The effect of USGET combined with eccentric exercise appears to be a safe and effective technique for achieving pain relief and functional recovery in the medium term, supporting the integrated use of USGET as a rehabilitative treatment option for patients with chronic AT.
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Tendón Calcáneo , Tendinopatía , Ultrasonografía Intervencional , Humanos , Tendinopatía/rehabilitación , Tendinopatía/terapia , Tendinopatía/diagnóstico por imagen , Proyectos Piloto , Tendón Calcáneo/diagnóstico por imagen , Femenino , Persona de Mediana Edad , Masculino , Adulto , Resultado del Tratamiento , Ultrasonografía Intervencional/métodos , Electrólisis , Dimensión del Dolor , Modalidades de Fisioterapia , Terapia por Estimulación Eléctrica/métodosRESUMEN
BACKGROUND: Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity. METHODS: A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively. RESULTS: Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018). CONCLUSION: Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity.